Table of contents
Irritability, anxiety and sadness after quitting smoking are typical nicotine withdrawal symptoms. They are usually strongest in the first week without a cigarette and ease within 2-4 weeks (1). In some people, however, low mood does not go away or deepens from week to week. In that case, you need to consult a doctor to check whether an episode of depression has started. A review of studies also shows that, in the longer term, quitting smoking does not harm mental health: people who stopped smoking had, on average, slightly fewer symptoms of anxiety and depression in these studies than people who continued to smoke (2).
In brief
- Irritability, anxiety, low mood and difficulty concentrating after quitting smoking are strongest in the first week and usually last 2-4 weeks. Loss of enjoyment is also one of these symptoms.
- You need to consult a doctor if low mood has not eased after about a month, is getting worse, makes it hard to work and manage everyday tasks, or comes with a sense of hopelessness. If you have thoughts of death, tell someone close to you and a doctor the same day.
- Chest pain is not a confirmed symptom of nicotine withdrawal. Crushing pain spreading to the arm, neck or jaw, or severe shortness of breath, when you are struggling to breathe, needs immediate medical help.
- In the first weeks, it helps to take a medicine that eases withdrawal symptoms, be active every day, cut down on coffee and talk to an addiction therapist or psychologist.
Why do irritability, anxiety and sadness appear after quitting smoking?
Irritability, anxiety and sadness appear after quitting smoking because the brain has got used to regular doses of nicotine. Once nicotine is stopped, the brain needs a few weeks to adapt to working without it. These symptoms are not a sign of weak willpower, nor do they mean that your attempt to quit is failing.
Nicotine stimulates nicotinic receptors in the brain and increases the release of dopamine, which is linked to feelings of pleasure. With daily smoking, the nervous system adapts to the constant presence of nicotine, and when nicotine is missing, withdrawal symptoms appear (3). John Hughes of the University of Vermont reviewed 120 studies on the effects of tobacco abstinence and identified anger, anxiety, low mood, difficulty concentrating and insomnia, among others, as confirmed symptoms.
Many smokers feel that cigarettes calm them down. The authors of a 2021 review suggest that a cigarette briefly relieves the anxiety, low mood and irritability that keep coming back between cigarettes as withdrawal symptoms (2). Smoking went together with work breaks, coffee and conversations, so after quitting, these are exactly the moments of the day when you miss a cigarette.
Why do you lose your sense of enjoyment after quitting smoking?
Lack of enjoyment, known in medicine as anhedonia, means that things that usually gave you pleasure no longer do. In a US study, 1,175 smokers rated how they felt several times a day for 5 days before quitting and 10 days afterwards. Lack of enjoyment increased after the quit day and then eased, in the same way as other withdrawal symptoms. People who felt it more strongly went back to smoking sooner (4).
In a further analysis, the same researchers looked at people taking placebo: their lack of enjoyment was strongest just after quitting. After about a week, there was no longer any difference in its severity between this group and people treated with nicotine or bupropion (5). Both analyses covered only the first 10 days after quitting. So these studies do not tell us how long lack of enjoyment lasts in people who still find no pleasure in anything after a few weeks.
How long does low mood last after quitting smoking?
Low mood after quitting smoking usually starts on the first day, is strongest in the first week and usually passes within a month. The US National Cancer Institute (NCI) states that in people who have never had depression, severe depression after quitting smoking is rare.
The table shows the typical course of symptoms according to Hughes's review and the NCI. In any one person, they may be shorter or longer.
| Symptom | When it starts | When it usually eases |
|---|---|---|
| Irritability, anger, impatience | in the first few days | strongest in week 1, lasts 2-4 weeks |
| Anxiety and feeling tense | within 24 hours, increasing over the first 3 days | may persist for several weeks |
| Sadness and low mood | usually on the first day | lasts several weeks, usually passes within a month |
| Lack of enjoyment | right after quitting | in studies, it eased within the first 10 days |
| Difficulty concentrating | in the first few days | strongest in week 1, lasts 2-4 weeks |
We describe the other symptoms, and what improves in the following months, in our article on quitting smoking day by day.
Cochrane, an international scientific organisation that collects and compares the results of studies on a given topic, brought together 102 studies involving more than 169,000 adults in 2021. In these studies, smokers' mental health was assessed before they quit and at least 6 weeks later. People who had stopped smoking then had slightly fewer symptoms of depression and anxiety than people who continued to smoke. The same was true among people with mental illness. The authors rated the certainty of these results as very low to moderate, because these were observational studies in which other factors could have influenced the results.
How can you work when it is hard to concentrate after quitting smoking?
Brain fog is an informal term for difficulty concentrating, slowed thinking and a feeling that it is hard to think clearly. Difficulty concentrating after quitting smoking follows a similar course to irritability: it is strongest in the first week and usually lasts 2-4 weeks (1). It is easier to get through this time at work if:
- your quit day is not in a week when you have to meet an important deadline, sit an exam or work on a difficult project
- your tasks and errands are written down, so you do not have to remember them all
- you go for a walk of a few minutes at the time of your old cigarette break. In an analysis of experimental studies, a short bout of physical activity clearly reduced the urge to smoke in people who had not smoked for a while (6).
- you drink less coffee than you did when you smoked. Tobacco smoke speeds up the breakdown of caffeine, so in people who kept drinking coffee after quitting smoking, caffeine levels in saliva after 3 weeks were roughly twice as high as at the start (7).
Hughes's review did not include sleepiness and tiredness among withdrawal symptoms. If these are the main problem, the cause may be lack of sleep, low mood or the effect of a medicine. Sleep disturbances, including sleepiness and lethargy, are very common side effects of Desmoxan tablets.
When should you see a doctor about low mood after quitting smoking?
Typical withdrawal symptoms ease within 2-4 weeks, so we advise consulting a doctor about possible depression if low mood or lack of enjoyment persists for most of the day, nearly every day, for longer than about a month after quitting. You need to consult a doctor sooner if your low mood gets worse from week to week or if a sense of hopelessness and thoughts of death appear. The one-month threshold is not a criterion for diagnosing depression, but a practical guide based on the typical course of withdrawal. The diagnosis is made by a doctor.
According to the World Health Organization (WHO), in a depressive episode, sadness, irritability, a feeling of emptiness or loss of interest and pleasure persist for most of the day, nearly every day, for at least 2 weeks. They come with other symptoms, such as excessive guilt, hopelessness about the future, thoughts of death, disturbed sleep and appetite, poor concentration and tiredness (8). Poorer sleep, increased appetite and weaker concentration also occur in nicotine withdrawal, however, so in the first weeks after quitting smoking they are of little help in telling withdrawal symptoms apart from depression. What matters more is how long the symptoms last, whether they are easing or getting worse, and what the person is thinking about.
| What to watch | Typical nicotine withdrawal | A signal to consult a doctor |
|---|---|---|
| Timing | symptoms start on the first day and ease within about a month | after about 4 weeks the symptoms are no less severe, or low mood appears only a few weeks after quitting |
| Change in severity | symptoms ease from week to week | symptoms get worse from week to week |
| Daily life | things are harder, but you manage to work and look after the home | it is hard to get out of bed, work, look after the children or eat a meal |
| Thoughts | anger, tension, the urge to smoke | guilt, worthlessness, hopelessness, thoughts of death |
Who is at higher risk of depression after quitting smoking?
According to the NCI, people who have had depression before have stronger withdrawal symptoms, including more severe low mood. A 1997 study followed 126 people who had managed to quit smoking in a 10-week nicotine dependence treatment programme. Within 3 months, a new episode of depression occurred in 2% of people who had never had depression, in 17% of people who had had one episode of depression and in 30% of people with recurrent depression. Regardless of past depression, the risk was higher in people whose withdrawal symptoms took a long time to pass (9). This is a single small study from almost 30 years ago. In this group, depression was more common among people who had had it before; the percentages should not be treated as current data on everyone who quits smoking. The authors recommend that people with a history of depression stay under medical care beyond the 2-4 weeks in which withdrawal symptoms usually occur.
Anyone receiving psychiatric treatment should agree a plan for quitting smoking with their psychiatrist, because quitting smoking, with or without medication, may be associated with a worsening of an existing mental illness, such as depression. After stopping cigarettes, the blood levels of some medicines also rise, including clozapine and olanzapine; we write about this in our article on quitting smoking with a doctor or on your own.
What should you do if you have thoughts of death after quitting smoking?
Low mood can be a symptom of nicotine withdrawal, including in people who quit without medication. In rare cases, it is accompanied by suicidal thoughts and suicide attempts (10). If thoughts of death or of taking your own life appear, you should not wait for them to go away on their own. You need to tell someone you trust and a doctor about them the same day. If you are taking a medicine to help you quit, the doctor will decide whether you should continue taking it.
If thoughts of suicide are persistent, you have a plan to take your own life, or it is hard to keep yourself safe, you need immediate medical help, without waiting for a booked appointment. Until you get help, it is better not to be alone; ask someone close to you to stay with you.
Is chest pain after quitting smoking caused by anxiety or by heart disease?
Chest pain is not a confirmed symptom of nicotine withdrawal, so new chest pain should not be put down to quitting smoking alone. Anxiety and panic attacks can cause symptoms similar to those of a heart attack, and they cannot be reliably told apart at home.
Hughes does not list chest pain among the symptoms of tobacco withdrawal. The UK's National Health Service (NHS), however, lists it among the symptoms of a panic attack, alongside palpitations, shortness of breath, sweating, nausea, dizziness and fear of dying (11). Chest pain, shortness of breath, nausea and sweating also occur in a heart attack, though (12). Smoking causes heart disease (13), so in someone who has smoked for years, new chest pain needs to be investigated, even if it appeared during a period of severe anxiety.
Palpitations can also be linked to a medicine for quitting smoking. A faster heart rate and high blood pressure are very common side effects of Desmoxan tablets. Cytisine is not used after a recent heart attack, in unstable angina or in clinically significant heart rhythm disorders. We explain how to tell the effects of the medicine from withdrawal symptoms in our article on the side effects of cytisine.
When do chest pain or shortness of breath need immediate help?
According to the NHS, the following need immediate medical help:
- pressing or crushing chest pain, especially if it spreads to the arm, neck or jaw
- severe shortness of breath, when you are struggling to breathe or speak
- pale, grey or bluish skin
- loss of consciousness
Sudden shortness of breath that is clearly worse than usual, and chest pain with nausea or a change in heart rhythm, such as a very fast, slow or irregular heartbeat, need urgent medical advice, preferably the same day. Recurrent anxiety attacks are also a reason for an appointment, at which the doctor can first rule out a heart-related cause and then treat the anxiety.
What helps improve your mood in the first weeks without a cigarette?
A medicine that eases withdrawal symptoms, daily physical activity, cutting down on coffee and talking to an addiction therapist or psychologist help to ease low mood in the first weeks without a cigarette. None of these methods removes the symptoms straight away.
A medicine to ease nicotine withdrawal symptoms
Cytisine (Desmoxan, Tabex, Recigar) moderately increases dopamine levels in the brain and in this way eases nicotine withdrawal symptoms. In the 2015 study by Cook et al., the feeling of lack of enjoyment after quitting barely increased in people using nicotine replacement therapy, such as nicotine patches or gum.
The medicine itself can also affect how you feel, because mood changes, anxiety and irritability are very common side effects of Desmoxan tablets. The choice of medicine depends on how much you smoke, what conditions you have and what medicines you take. If you have had depression in the past, have heart disease or are receiving ongoing psychiatric treatment, it is best to choose the medicine during a consultation with a doctor as part of nicotine dependence treatment.
At Nasz Gabinet, the 3-month treatment plan starts with a medical interview. Once you have been assessed as eligible, the doctor chooses the medicine and issues an e-prescription, and the Nasz Gabinet app gives you dose reminders, a smoke-free day counter and a diary. If needed, you can book a consultation with a psychologist, paid for separately.
Physical activity, seeing people and less caffeine
For people who feel low or tense after quitting smoking, the NCI recommends being physically active every day, preferably in a way they enjoy, meeting friends and spending a few minutes breathing deeply. For anxiety, the institute recommends drinking less coffee, tea and cola-type drinks.
Tips for people who find that food is starting to replace cigarettes are in our article on weight gain after quitting smoking. If a strong urge to smoke is the main cause of your low mood, we describe ways of getting through nicotine cravings in our article on how long nicotine cravings last.
Talking to an addiction therapist or psychologist
Talking to an addiction therapist or psychologist helps you prepare for the situations in which you used to smoke and for days when your mood is low. Researchers collected 65 studies involving more than 23,000 people who were taking a medicine to help them quit smoking. People who also talked to a counsellor in person or by telephone were about 10-20% more likely to still be smoke-free after at least six months than people with less support or none. So if 20 in 100 people are not smoking with less support, about 22-24 are not smoking with additional support (14).
Tell the people close to you that withdrawal symptoms last for weeks, not a few days, and that your irritability during this time is not aimed at them.
This article does not replace a medical consultation.
Frequently asked questions
How long does depression after quitting smoking last?
Depression and a temporary dip in mood after stopping nicotine are different problems. The mild dip in mood described by the NCI usually starts on the first day and passes within a month. This does not mean that diagnosed depression will also resolve within this time. The diagnosis is made by a doctor. If low mood has not eased after about 4 weeks, is getting worse, makes it hard to work or comes with thoughts of death, you need to consult a doctor. Anyone who has already had an episode of depression should discuss a plan for quitting smoking with a doctor before giving up cigarettes.
Can you have panic attacks after quitting smoking?
Panic attacks after quitting smoking are not listed separately in Hughes's review of withdrawal symptoms, but anxiety is one of the most common of these symptoms and, according to the NCI, builds up over the first 3 days. A panic attack brings palpitations, chest pain, shortness of breath and sweating, and usually lasts 5-20 minutes. Similar symptoms occur in a heart attack, so after the first such episode you need to see a doctor.
Can cytisine make your mood worse?
Cytisine can affect mood. Mood changes, anxiety and irritability are very common side effects of Desmoxan tablets, meaning they occur in at least 1 in 10 people. However, these symptoms may also be caused by quitting smoking itself rather than by the medicine. If your symptoms are severe, tell a doctor or pharmacist before any change to the dose. If you have thoughts of death or a sudden change in behaviour, you need to contact a doctor the same day.
Will one cigarette improve my mood after quitting smoking?
One cigarette will briefly ease withdrawal symptoms, because it supplies nicotine, but it will not remove the cause of the low mood. In the study by Cook et al., people who felt a stronger lack of enjoyment after quitting went back to smoking sooner. If your symptoms are severe, it is better to discuss a change of treatment with a doctor. If you have already smoked a cigarette, we describe what to do in the following hours in our article I smoked after quitting.
Sources
- Hughes JR. Effects of abstinence from tobacco: valid symptoms and time course. Nicotine Tob Res. 2007;9(3):315-327. PMID 17365764, DOI
- Taylor GM, Lindson N, Farley A et al. Smoking cessation for improving mental health. Cochrane Database Syst Rev. 2021;3(3):CD013522. PMID 33687070, DOI
- Benowitz NL. Nicotine addiction. N Engl J Med. 2010;362(24):2295-2303. PMID 20554984, DOI
- Cook JW, Piper ME, Leventhal AM et al. Anhedonia as a component of the tobacco withdrawal syndrome. J Abnorm Psychol. 2015;124(1):215-225. PMID 25384069, DOI
- Cook JW, Lanza ST, Chu W et al. Anhedonia: Its Dynamic Relations With Craving, Negative Affect, and Treatment During a Quit Smoking Attempt. Nicotine Tob Res. 2017;19(6):703-709. PMID 28486709, DOI
- Haasova M, Warren FC, Ussher M et al. The acute effects of physical activity on cigarette cravings: systematic review and meta-analysis with individual participant data. Addiction. 2013;108(1):26-37. PMID 22861822, DOI
- Swanson JA, Lee JW, Hopp JW, Berk LS. The impact of caffeine use on tobacco cessation and withdrawal. Addict Behav. 1997;22(1):55-68. PMID 9022872, DOI
- World Health Organization. Depressive disorder (depression). Fact sheet. who.int
- Covey LS, Glassman AH, Stetner F. Major depression following smoking cessation. Am J Psychiatry. 1997;154(2):263-265. PMID 9016279, DOI
- Charakterystyka Produktu Leczniczego Desmoxan, 1,5 mg, tabletki (data zmiany tekstu 31.10.2025) [summary of product characteristics, in Polish]. Rejestr Produktów Leczniczych
- NHS. Panic disorder. nhs.uk
- NHS. Heart attack: symptoms. nhs.uk
- National Cancer Institute. Harms of Cigarette Smoking and Health Benefits of Quitting. cancer.gov
- Hartmann-Boyce J, Hong B, Livingstone-Banks J et al. Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation. Cochrane Database Syst Rev. 2019;6(6):CD009670. PMID 31166007, DOI
- National Cancer Institute. Handling Nicotine Withdrawal and Triggers When You Decide To Quit Tobacco. cancer.gov
Quitting smoking and worried about your mood?
In the Nasz Gabinet app, you can start a 3-month treatment plan that includes a medical interview and an e-prescription. You can also book a consultation with a psychologist.
